Background: Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support during treatment in patients with head and neck cancer, but long-term nutritional outcomes have not been reported in detail. The purpose of this study was to determine short- and long-term outcomes and success in meeting nutritional goals in patients with head and neck cancer who had PEGs placed over an 18-year period.
Methods: Medical records of all patients who had PEG procedures performed by one of the authors (REB) from 1997 through 2010 were reviewed. Demographic data, patient weights, timing of procedure in relation to cancer treatment, complications, and long-term outcomes were recorded.
Results: Five hundred and sixty-five patients with head and neck cancer underwent PEG. Mean age was 59.6 ± 13.6 years; 71% were men. Mean follow-up was 33 ± 38 months. 99% of PEGs were used for nutritional support. Average weight loss prior to PEG was 23 ± 17 lbs (range 0-133 lbs). Average weight loss between PEG and completion of treatment was 2.3 lbs; 44% of patients gained weight or remained stable after PEG. There were no PEG-related deaths. Complications included cellulitis in 27 (4%), pain in 14 (2.5%); leakage in 11 (2%), self-limited gastric bleeding in one patient. PEGs were used an average of 8.1 months. No PEG site tumor implants were observed. Among 366 patients treated with intention to cure, 45% were alive an average of 68 months later.
Conclusions: PEG is both safe and efficacious in arresting weight loss and maintaining nutrition in patients undergoing surgery and/or chemoradiotherapy for head and neck cancer. PEG can be recommended for patients in whom dysphagia and weight loss is anticipated or in whom weight loss occurs as a result of their treatment; 20% of patients will need the PEG for a year or more.
Keywords: Cancer of the head and neck; Endoscopy; Enteral nutrition; Gastrostomy.